Furosemide


Thông tin thuốc gốc
Chỉ định và Liều dùng
Intramuscular, Intravenous
Oedema
Adult: Initially, 20-50 mg. Doses are individualised and may be increased in increments of 20 mg 2 hourly. Max: 1,500 mg daily. Doses are given via slow IV inj or via IM inj if IV administration is not feasible. Doses >50 mg must be given via slow IV infusion. Max IV infusion or inj rate: 4 mg/min. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Initiate at lower doses and dosage should be adjusted until desired effect is achieved.
Child: 0.5-1.5 mg/kg daily. Max: 20 mg daily.
Neonate: For the treatment of cases associated with heart failure, cirrhosis of the liver, and renal disease including nephrotic syndrome:
Postmenstrual Age Dosage
<31 weeks Usual dose: 1 mg/kg. Dosage range: 0.5-2 mg/kg 24 hourly.
≥31 weeks Usual dose: 1 mg/kg. Dosage range: 0.5-2 mg/kg 12 hourly.
All doses may be given via intermittent IV inj or via IM injection.

Term neonate Usual dose: 1 mg/kg 12-24 hourly. Dosage range: 0.5-2 mg/kg 12-24 hourly. All doses may be given via intermittent IV inj or via IM inj. Alternatively, an initial IV bolus of 1-2 mg/kg may be given, followed by a continuous IV infusion at a range of 0.1-0.4 mg/kg/hour. Dosage recommendations may vary among countries and individual products (refer to detailed product guideline).

Oral
Hypertension
Adult: As monotherapy or in combination with other antihypertensives: 40-80 mg daily. Dosage is individualised and adjusted according to patient response. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Initiate at lower doses and dosage should be adjusted until desired effect is achieved.

Oral
Oliguria in acute or chronic renal failure
Adult: For the treatment of cases where GFR is <20 mL/min: Initially, 250 mg. If a satisfactory effect is not achieved, doses may be increased in increments of 250 mg every 4-6 hours up to a Max dose of 1,500 mg in 24 hours; in severe cases up to 2,000 mg in 24 hours may be given. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Dosage should be adjusted until desired effect is achieved.
Child: >12 years For the treatment of cases where GFR is <20 mL/min: Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).

Oral
Oedema
Adult: For the treatment of cases associated with heart failure, cirrhosis of the liver, and renal disease including nephrotic syndrome: Initially, 20-40 mg. Doses are individualised and adjusted until desired effect is achieved. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Initiate at lower doses and dosage should be adjusted until desired effect is achieved.
Child: For the treatment of cases associated with heart failure, cirrhosis of the liver, and renal disease including nephrotic syndrome: Initially, 2 mg/kg daily as a single dose. If the desired effect is not achieved, doses may increased by 1-2 mg/kg given 6-8 hours after the previous dose. Max: 6 mg/kg. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Neonate: For the treatment of cases associated with heart failure, cirrhosis of the liver, and renal disease including nephrotic syndrome:
Postmenstrual Age Dosage
<31 weeks Usual dose: 1 mg/kg. Dosage range: 0.5-2 mg/kg 24 hourly.
≥31 weeks Usual dose: 1 mg/kg. Dosage range: 0.5-2 mg/kg 12 hourly.
Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Suy thận
Intravenous/Intramuscular:
Severe: Max IV infusion rate: 2.5 mg/min.
Cách dùng
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Tương kỵ
Incompatible with diazepam, diltiazem, dobutamine, dopamine, droperidol, doxorubicin, gentamicin, isoprenaline, labetalol, lidocaine, metoclopramide, midazolam, milrinone, morphine, pethidine, nicardipine, vecuronium bromide, parenteral nutrient solutions, cisatracurium, levofloxacin, phenylephrine, vasopressin, vincristine, tetracycline, glucose solutions, acidic solutions.
Chống chỉ định
Hypersensitivity to furosemide, sulfonamides or sulfonamide derivatives, and amiloride. Electrolyte deficiency (e.g. severe hypokalaemia or hyponatraemia), Addison's disease, porphyria, dehydration, hypotension, hypovolaemia, comatose or pre-comatose states associated with hepatic cirrhosis or encephalopathy, anuria or renal failure with anuria not responding to furosemide, renal failure due to poisoning with nephrotoxic or hepatotoxic agents, renal failure due to hepatic coma. Jaundice in infants, or diseases which may cause hyperbilirubinaemia or kernicterus. Renal impairment CrCl <30 mL/min/1.73 m2. Digitalis intoxication; concomitant use with K supplements or K-sparing diuretics. Lactation.
Thận trọng
Patient with prediabetes or diabetes mellitus, prostatic hyperplasia, gout, hepatorenal syndrome, hypoproteinaemia, acute hypercalcaemia; at risk from a pronounced fall in blood pressure, diuretic resistance. Patient undergoing surgery. Not recommended for patients at high risk for radiocontrast nephropathy. Correct hypovolaemia, hypotension, severe electrolyte disturbance (particularly hypokalaemia, hyponatraemia, and acid-base disturbances) before treatment initiation. Renal and hepatic impairment. Neonates, children, and elderly. Pregnancy.
Tác dụng không mong muốn
Significant: Hyperuricaemia, transient increase in thyroid hormones followed by decrease in total thyroid hormone level (doses >80 mg), SLE activation or exacerbation, urinary retention; hypotension, hypovolaemia, dehydration; impaired glucose tolerance, hyperglycaemia. Rarely, may cause gout.
Blood and lymphatic system disorders: Thrombocytopenia.
Cardiac disorders: Cardiac arrhythmias.
Ear and labyrinth disorders: Deafness, hearing disorders, tinnitus.
Eye disorders: Visual disturbance, blurred vision, yellow vision.
Gastrointestinal disorders: Nausea, vomiting, dry mouth, thirst, bowel motility disturbances, diarrhoea, constipation.
General disorders and administration site conditions: Fatigue.
Investigations: Increased cholesterol, triglycerides level, blood creatinine, and blood urea levels.
Metabolism and nutrition disorders: Hyponatraemia, hypochloraemic metabolic alkalosis, hypocalcaemia, hypomagnesaemia.
Musculoskeletal and connective tissue disorders: Muscle cramps, muscle weakness.
Skin and subcutaneous tissue disorders: Photosensitivity.
Potentially Fatal: Profound diuresis with water and electrolyte depletion (excessive dose). Increased risk of ventricular arrhythmias due to furosemide-induced hypokalaemia.
IM/IV/Parenteral/PO: C
Thông tin tư vấn bệnh nhân
This drug may cause reduced mental alertness, dizziness, and blurred vision, if affected, do not drive or operate machinery.
Chỉ số theo dõi
Monitor blood pressure, serum electrolytes (e.g. serum Na, K), renal function, and blood glucose levels periodically; fluid intake and output. Monitor for signs and symptoms of blood dyscrasias, liver damage, and idiosyncratic reactions.
Quá liều
Symptoms: Hypovolaemia, dehydration, blood volume reduction, electrolyte imbalance, hyponatraemia, hypochloraemic alkalosis; hypokalaemia leading to serious cardiac arrhythmias; severe hypotension progressing to shock, acute renal failure, thrombosis, delirium, flaccid paralysis, apathy, confusion, transient deafness, precipitation of gout. Management: Symptomatic and supportive treatment. Replacement of excessive fluid and electrolyte losses, maintenance of blood pressure. May consider giving activated charcoal within 1 hour of ingesting toxic doses. Ensure adequate drainage in patients with urinary bladder outlet obstruction (e.g. prostatic hypertrophy). Treat dehydration and hypotension with appropriate IV fluids.
Tương tác
Antagonised diuretic effect and increased risk of nephrotoxicity with NSAIDs. Increased risk of profound diuresis with metolazone. Increased risk of hypokalaemia with thiazides, β2-sympathomimetics, theophylline, corticosteroids, carbenoxolone, laxative (prolonged-use), reboxetine, amphotericin B, and corticosteroids. May attenuate the effect of anti-diabetic agents. Reduced effect with probenecid, methotrexate, and phenytoin. May increase the risk of adverse effects of digoxin and other digitalis glycosides; cardiac toxicity of anti-arrhythmic drugs (e.g. amiodarone, disopyramide, flecainide, quinidine, sotalol) due to furosemide-induced hypokalaemia. May antagonise the effect of lidocaine, tocainide, and mexiletine. May enhance the hypotensive effect of vasodilators (e.g. thymoxamine, hydralazine). Reduced plasma concentration with aliskiren, Enhanced hypotensive effect with theophylline, nitrates, phenothiazines, levodopa, MAOIs, baclofen, tizanidine, general anaesthesia, and alprostadil. Increased risk of postural hypotension with TCAs. May increase the serum level of lithium. May enhance the nephrotoxic and ototoxic effects of aminoglycosides. Increased risk of ototoxicity with vancomycin, polymyxins (e.g. colistin), and cisplatin. May cause impaired renal function with concomitant use of high-dose cephalosporins. Increased risk of hyponatraemia with trimethoprim, and aminoglutethimide. May decrease the renal elimination of methotrexate. Increased risk of gouty arthritis with cisplatin. May displace thyroid hormone from binding sites with concomitant use of chloral hydrate. May increase or decrease the effect of neuromuscular blocking agents. Antagonised diuretic effect with estrogens.
Potentially Fatal: Increased risk of mortality in elderly with dementia with concomitant use with risperidone.
Tương tác với thức ăn
Enhanced hypotensive effect with alcohol.
Ảnh hưởng đến kết quả xét nghiệm
May result in a false-negative aldosterone/renin ratio (ARR).
Tác dụng
Description:
Mechanism of Action: Furosemide is an anthranilic acid derivative and a potent diuretic. It mainly inhibits the reabsorption of Na and chloride in the ascending loop of Henle and in both the proximal and the distal renal tubules, interfering with the chloride-binding cotransport system, thereby causing its natriuretic effect.
Synonym(s): Frusemide.
Onset: Diuresis: 30-60 minutes (oral); approx 5 minutes (IV). Symptomatic improvement in acute pulmonary oedema: Within 15-20 minutes prior to diuretic effect.
Duration: 6-8 hours (oral); approx 2 hours (IV).
Pharmacokinetics:
Absorption: Fairly rapidly absorbed from the gastrointestinal tract. Bioavailability: 47-64% (tab); 50% (oral solution). Time to peak plasma concentration: 1-2 hours (oral); 30 minutes (IV).
Distribution: Crosses the placenta and enters breast milk. Plasma protein binding: 91- 99%, mainly to albumin.
Metabolism: Undergoes minimal metabolism in the liver.
Excretion: Mainly via urine (50% [oral]; 80% [IV]); faeces (as unchanged drug). Elimination half-life: 0.5-2 hours (oral/IV).
Đặc tính

Chemical Structure Image
Furosemide

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3440, Furosemide. https://pubchem.ncbi.nlm.nih.gov/compound/Furosemide. Accessed Aug. 14, 2023.

Bảo quản
Store between 15-30°C. Protect from light.
Phân loại MIMS
Thuốc lợi tiểu
Phân loại ATC
C03CA01 - furosemide ; Belongs to the class of high-ceiling sulfonamide diuretics.
Tài liệu tham khảo
Anon. Furosemide (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/06/2023.

Anon. Furosemide. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/07/2023.

Anon. Furosemide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/06/2023.

Arrotex Pharmaceuticals (NZ) Limited. Urex Forte 500 mg Tablets data sheet 18 January 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 13/06/2023.

Buckingham R (ed). Furosemide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/06/2023.

Frusol 20 mg/5 mL Oral Solution (Rosemont Pharmaceuticals Ltd). MHRA. https://products.mhra.gov.uk. Accessed 13/06/2023.

Furosemide 40 mg Tablets (Crescent Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 05/07/2023.

Furosemide Injection (Wockhardt USA LLC.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/07/2023.

Furosemide Injection BP (Accord-UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 13/06/2023.

Furosemide Tablets BP 500 mg (Hameln Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 21/06/2023.

Furosemide. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 05/07/2023.

Joint Formulary Committee. Furosemide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/06/2023.

Joint Formulary Committee. Furosemide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/06/2023.

Lasix Tablet (Sanofi-Aventis [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 13/06/2023.

Lasix Tablet (Validus Pharmaceuticals LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 13/06/2023.

Sanofi-Aventis New Zealand Limited. Lasix Oral Solution 10 mg/mL and Lasix High Dose Solution for Infusion 10 mg/mL data sheet 23 August 2018. Medsafe. http://www.medsafe.govt.nz. Accessed 07/05/2023.

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